Natural glucocorticoids are hormones or signaling molecules. Hormones are released by glands in the body and travel through the circulatory system to other organs and tell them to do something. In the case of glucocorticoids, they are secreted by the adrenal cortex, which sits on top of each of our kidneys and they work on many different areas throughout the body.
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| Hulk = anabolic; Bruce Banner = catabolic |
These hormones are steroids...but not the kind that body builders take to bulk up their muscles. These steroids are catabolic, which break things down, and in this case 'break down' or inhibit the immune system, which is believed to cause the issues with the foot processes of the podocytes on the glomeruli.
They are widely used in treatment for minimal change disease but the specific benefits are not understood very well. Some theories suggest that steroids help by inhibiting effects of both the innate immune system (the one you are born with ) and the acquired immune system (the one that you build up when you get sick.) Steroids inhibit the inflammatory response of the innate immune system and inhibit t-cell activity in the acquired immune system. (T-cells are the white blood cells that attack infection that they recognize and may play a role in attacking podocytes in minimal change disease.)
When an adult patient starts on a treatment plan of glucocorticosteroids, experts expect the disease to be gone (or in complete remission) in 8-12 weeks. With pediatric patients, remission is expected within 4-6 weeks. Treatment will typically continue for another six weeks following remission to allow the patient to slowly taper off of the glucocorticosteroids.
Some adverse effects of steroid treatment include -
- A compromise of the immune system due to inhibition.
- Hyperglycemia, or increased blood sugars. These steroids can actually cause diabetes in people.
- Increased bruising of the skin.
- A calcium imbalance in the system, which can be bad for your heart and bones
- Weight gain.
- Impaired memory and attention deficit.
If any of these side effects become too severe, treatment with a particular drug will be halted and a different glucocorticosteroid will be tried. Prednisone is a common oral steroid that is prescribed.
Minimal Change Disease is relatively easy to treat once it has been discovered. A glucocorticosteroid is given to suppress the immune system and allow the podocytes time to heal/realign. Often times, the disease may result in a relapse later in life. The same course of action may be taken with a relapse.
References:
www.uptodate.com/contents/treatment-of-minimal-change-disease-in-adults
web.standford.edu/group/hopes/cgi-bin/wordpress/2010/06/glucocorticoids/
http://medicine.med.nyu.edu/nephrology/files/med_nephrology/attachments/MCD.ppt.
